title: The association of plasma lactate with incident cardiovascular outcomes: the ARIC Study.
abstract: We examined the association of plasma lactate at rest, a marker of oxidative capacity, with incident cardiovascular outcomes in 10,006 participants in the Atherosclerosis Risk in Communities (ARIC) Study visit 4 (1996-1998). We used Cox proportional-hazards models to estimate hazard ratios of incident coronary heart disease, stroke, heart failure, and all-cause mortality by quartiles of plasma lactate (Q1, ≤5.3 mg/dL; Q2, 5.4-6.6; Q3, 6.7-8.6; and Q4 ≥8.7). During a median follow-up time of 10.7 years, there were 1,105 coronary heart disease cases, 379 stroke cases, 820 heart failure cases, and 1,408 deaths. A significant graded relation between lactate level and cardiovascular events was observed in the demographically adjusted model (all P for trend < 0.001). After further adjustment for traditional and other potential confounders, the association remained significant for heart failure (Q4 vs. Q1: hazard ratio (HR) = 1.35, 95% confidence interval (CI): 1.07, 1.71) and all-cause mortality (HR = 1.27, 95% CI: 1.07, 1.51) (P for trend < 0.02 for these outcomes) but not for coronary heart disease (HR = 1.02, 95% CI: 0.84, 1.24) and stroke (HR = 1.26, 95% CI: 0.91, 1.75). The results for heart failure were robust across multiple subgroups, after further adjustment for N-terminal pro-B-type natriuretic peptide and after exclusion of participants with incident heart failure within 3 years. The independent associations of plasma lactate with heart failure and all-cause mortality suggest an important role for low resting oxidative capacity.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA. kmatsush@jhsph.edu
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Matsushita
authors.forename: Emma K
authors.initials: EK
authors.lastname: Williams
authors.forename: Morgana L
authors.initials: ML
authors.lastname: Mongraw-Chaffin
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.forename: Maria Ines
authors.initials: MI
authors.lastname: Schmidt
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Brancati
authors.forename: Ron C
authors.initials: RC
authors.lastname: Hoogeveen
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.forename: J Hunter
authors.initials: JH
authors.lastname: Young
mesh_terms: D000428:Alcohol Drinking / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D055812:Community-Based Participatory Research; D015897:Comorbidity; D003327:Coronary Disease / Q000097:blood* / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D016016:Proportional Hazards Models; D012907:Smoking / Q000453:epidemiology; D020521:Stroke / Q000097:blood* / Q000453:epidemiology*; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D019344:Lactic Acid
keywords: cardiovascular disease; epidemiology; heart failure; oxidative capacity; plasma lactate